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During his visit to California last week, President Obama hailed the state’s leading role in implementing the Affordable Care Act. Among the achievements he highlighted was the recent announcement that 13 health plans would be providing Californians affordable health insurance in the soon-to-open state-run marketplace called, Covered California.

But as KPCC’s Stephanie O’Neill tells us, California still faces challenges in implementing the law, including some that are unique to the Golden State.

It’s widely accepted that the biggest hurdle facing successful implementation of the federal health law in California is rampant confusion about it among pretty much everybody.

The Affordable Care Act takes full effect on January 1, 2014 and requires nearly every American to have health insurance. Those who don't have to pay a penalty, which starts out $95 a year in 2014 or 1 percent of income then grows to $695 a year or 2.5 percent of income.

"The immediate challenge is educating people and having people become aware that if you’re uninsured or underinsured, you now have an opportunity to get health insurance coverage and you’re actually mandated to get it as well," said Assemblyman Richard Pan (D-Sacramento), chairman of the Assembly Health Committee.

Health policy Analyst Jeff Goldsmith, president of Health Futures, Inc. says getting the word out in a state as large and diverse as California — where an estimated 5.3 million uninsured people will be required to buy health coverage — poses a unique challenge.

"This is an incredibly diverse complex state," said Goldsmith. "All the complexities of a large industrial nation resides here. You’ve got all of the language issues, you’ve got the tremendous ethnic and cultural diversity…There’s no such thing as 'a' Californian."

Peter Lee, executive director of Covered California, agrees. To begin addressing that he last month announced $37 million in federal grants to fund grass-roots education of consumers and small businesses. The goal, he says, is to reach everyone from non-English speakers to people who are geographically isolated.

"Because what it’s going to take on January one 2014 is partnership," said Lee. "It's going to be a huge task, but it's a task that's doable because Californians are coming together to make this change happen."

It’s also going to take translating the basics of the new law into the more than 100 languages spoken statewide.

"We have a lot of people who are spending a lot of time going through those details and planning to make sure we have language interpretation services available," said Andrea Rosen, interim health plan management director for Covered California.

Rosen says she's confident that no matter what language a person speaks they’ll have the help they need in choosing a health plan when the statewide marketplace open on October 1.

While that won’t be an easy task, far more challenging will be getting the young and healthy to buy health insurance.

"One of the things that we need to be sure happens is that we have actually a sufficient pool of healthy people to sign up for these insurance products because if it’s just the sick people who go in then that’s going to drive the costs up," said Pan.

Encouraging the young and healthy to buy insurance is going to take some innovative marketing.

Step one requires helping the "Young Invincibles" – as they’re coming to be known – to understand that even though they may not need day-to-day health care, the risk of accident or disease is always present.

Susan Dentzer, senior policy advisor for the Robert Wood Johnson Foundation, says one way to reach the estimated two million uninsured Californians between the ages of 19 and 34 is by marketing to women.

"To have their mothers and their aunts and their grandmothers talk to them about it," said Dentzer. "Because we know most of the health care decisions, frankly, are made in the country by women on behalf of their families and their loved ones."

As these broad challenges take center stage in California, many more subtle ones are percolating to the surface. Doctors groups and hospitals, for instance, are anxiously awaiting word on who among them will be included as providers in the 13 health plans chosen by Covered California.

There’s also concern about whether there are going to be enough doctors. California already faces a shortage of primary care physicians, and the massive influx of newly-insured patients is certain to make things even worse.

Lawmakers in Sacramento are responding by trying to expand what nurse practitioners and others can do. But it’s not clear those efforts will succeed, and even if they do, there still may not be enough medical practitioners to go around come January first.

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